Frequently Reported Treatment Goals and Issues Assessed Among Clinicians in Rape Crisis Centers

Background: Clinicians in Rape Crisis Centers (RCCs) provide crucial services to survivors of sexual abuse and sexual assault, and are viewed within the community as the primary resource for addressing the needs of victims of sexual violence.  While the consequences of sexual violence are well documented, comparatively little is known about the service sector tasked with addressing these consequences, including the treatment goals identified and assessment strategies used by clinicians.  The current study addresses this gap, asking these research questions:  What do clinicians working in RCCs see as the commonly desired outcomes of their treatment?  What outcomes do clinicians routinely assess for prior to providing treatment?  What outcomes do clinicians routinely assess for using standardized measures?  Are there differences in treatment goals or assessment strategies by provider education or agency setting (urban/rural)?

Methods: Clinicians in all rape crisis centers in Texas (n=83) were invited to participate in an on-line survey about their practice approaches. The final sample included 76 clinicians representing 47 agencies (57% response rate).  Participants were asked a series of questions related to their treatment goals and desired outcomes, what they assess prior to treatment, and how they evaluate their progress. They were given a list of 13 possible treatment goals spanning domains including mental health, daily functioning, and self-efficacy/empowerment.  Analysis included descriptive statistics and chi-square tests for differences between groups.

Results: The most highly endorsed desired treatment outcomes were enhancing self-esteem & confidence (99%)and a sense of empowerment (94%), relational functioning (93%),  general trauma symptoms (91%), anxiety (90%), depression (87%),PTSD (86%).   48% endorsed abuse of drugs/alcohol .  Most clinicians assessed mental health functioning prior to treatment: general trauma symptoms (86%), depression (81%), anxiety (78%) and PTSD (68%). However, use of standardized measures was low across all domains, ranging from 10% for sexual functioning to a high of 39% for depression. A minority of clinicians used standardized measures for anxiety (36%) and PTSD (34%). There were no significant differences by educational attainment on desired outcomes, but clinicians with a bachelor’s degree or less were statistically more likely to assess self-esteem (.008) and a sense of empowerment (.05), and to use standardized instruments for general functioning (.05) and self-esteem (.05). Clinicians in urban settings were statistically more likely than those in rural settings to endorse desired treatment outcomes related to PTSD (.05) and anxiety (.01), but there were no significant differences in use of standardized measures for these outcomes or any others.

Conclusions and Implications: Sexual violence generates a wide array of consequences and clinicians in RCCs are particularly interested in enhancing empowerment and relational functioning, and reducing trauma symptoms in survivors. Pretreatment assessments are being conducted across urban and rural settings by clinicians at different levels of educational attainments, but rarely with standardized measures and with few statistically significant differences between them. RCC clinicians need access to free standardize measures across a broad constellation of trauma symptoms that are easy to administer and score to enhance the accuracy of assessment, treatment planning and evaluation of treatment outcomes.